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Year 3 Sem 1 > Week 12 > Flashcards

Week 12 Flashcards

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1
Q

which patients are clinically determined higher risk for CVD?

A 
diabetes >60y/o
diabetes with microalbulineamia 
ABTSI >74
CKD
previous dx of familial hypercholesteraemia 
serum cholesterol >7.5 
SBP >180 DBP> 110
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2
Q

what are the lifestyle modifications given to low risk CVD patients?

A

at least 30 min of moderate exercise most days
smoking cessation
reduce was it circumference to 94 for men and 80 cm for women
BMI less than 25kg/m2
<4g/day of salt
no more than 2 SD/day of alcohol

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3
Q

what is the aim for lipid therapy?

A 
total cholesterol <4
HDL >1
LDL <2
TG <2
nonHLD chol <2.5
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4
Q

high risk: lipid lowering recipients?

A

CHD or peripheral vascular disease which has become symptomatic
DM
family hx of CHD which has become symptomatic by the age of 55 in 2+ 1st degree relatives OR by the age of 45 in 1+ 1st degree relatives

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5
Q

5 palliative care principles?

A 
focus on QOL
whole person approach 
care encopasses dying per and those that matter to them 
patient autonomy and chouce
open and sensitive community
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6
Q

4 common medications used in palliative carE?

A

nausea
pain
agitation
resp secretions

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7
Q

some points about palliative care?

A

provide relief from pain
not to prolong life
provide support for the patient and the family
incorporate spiritual and psychological aspects into care
team approach to address the needs of the patient and family
enhance QOL
application early in the course of illness

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8
Q

ARP?

A

acute resuscitation plan
- queensland health document for hospital

provides consistent documentation of clinical recommendations to withhold/ withdraw life sustaining measures, CPR and assisted ventilation
not a legal document but aims to guide clinicians if patient were to lose mental capacity

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9
Q

AHD?

A

advanced health directive
- clunk legal document
document that states your wishes and directions regarding your future health care for various medical conditions

may wish to happy AHD when you are unable to decide for yourself or you may want to only apply it when you are terminally ill

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10
Q

enduring power of attorney?

A

for welfare and finances

act on someones behalf regarding legal and financial matters

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11
Q

state of choice document?

A

value based document that records a patients wishes/ choices for their health care into the future

not a legal document but promotes EOL care discussion

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12
Q

consent order of priority?

A

patient has mental capacity and directs care
valid AHD
guardian appointed by tribunal
attorney appointed under most enduring document
statuary health directive
adult guardian

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13
Q

informed consent?

A

competence and capacity
voluntariness
disclosure of info
understanding and accepting info

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14
Q

what patients need in palliative care?

A 
mental capacity
advanced care planning
will
ARP
EPoA
AHD
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15
Q

6 steps in verification of death?

A 
no breath sounds 2 min 
no breathing effort/ breath felt
no carotid pulse
ho heart sound 2 min
fixed dilated pupils
no respones to noxious stimuli 
re-check patient identification
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16
Q

FLIP?

A 
identify the problem
analyze the problem
design solutions
plan your program 
evaluate
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17
Q

evaluation in flip?

A

SMART- specific, measurable, achievable, relevant, timely

outcome evaluation - did you achieve your goals
impact evaluation - did you active your objective
process evaluation - did your strategies work?

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18
Q

type of genetic mutation in PID?

A

recessive mutations of single genes

many are subclinical

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19
Q

what is the most common PID?

A

selective IgA deficiency

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20
Q

what is the most common clinical manifestation in IgA deficiency?

A

autoimmune diseases

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21
Q

examples of some encapsulated extracellular bacteria

A 
these are the most virulent
Escherichia coli (in some strains)
Neisseria meningitidis.
Haemophilus influenzae.
streptococcus pneumonia
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22
Q

what kind of pathogen is mycobacterium TB?

A

intracellular

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23
Q

what immune deficiencies results in mycobacterium?

A

(IC bacteria)
T cell def
NKC def
IL12

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24
Q

what defencies result in infection with encapsulated EC bacteria?

Study These Flashcards
A

B cell or complement def

25
what deficiencies results in viruses (herpes, varicella, CMI)?
T cell def | IL12/ NKC defects
26
deficiencies results in enterovirus?
B cell def
27
deficiencies that result in fingal infections?
T cell def | or phagocyte defects
28
defects resulting in parasitic infection?
B cell def | T cell def
29
defects resulting in opportunistic infections?
T cell def
30
what are some infections associated with low CD4 T cell count?
parasites IC bacteria (mTB, salmonella) fungi viruses ( herpes simplex, cytomegalovirus, herpes zoster)
31
what are some flags indicating immunodeficiency?
hx of repeated infections (unusual frequency of infections, recurrent chronic infections, infections affecting a particular body site, unable to respond to standard microbial therapy) ``` lymphanopenia or hypogammaglobulineamia inability to respond to vaccines low AB production disease affecting particular family opportunistic infections localized infection may become systemic ```
32
what is brutons tyrosine kinase important for?
development and normal functioning of B cell XLA - mutation in BTK enzyme = stops B cell maturation and no B cells leave BM = no circulating Ab of all classes little IgM almost exclusively occurs in men (1 Xchron)
33
different classes of PID and examples?
T cell and combined immunodeficiencies (SCID, AIDS) B cell immunodeficiencies (hyperIgM, XLA, selective IgA deficiency, hypogammaglobulineamis of infancy) complement and phagoctytic cell defiencies (chronic granulomatous disease, leukocyte adhesion deficiency, chediak hagashi syndrome (WBC dysfunction - decreased phagocytosis))
34
different classes of B cell defs in PID?
``` defects in early B cell development (BTK def = XLA) defects in class switching (defects in the signals that T cell gives B cell = hyperIgM) common variable immunodeficiencies (defects in AB production) ```
35
some features of selective IgA def?
due to a B cell defect ind are normally asymptomatic but with mild GI/ resp infections/ allergic disorder; recurrent sinus infections and autoimmune diseases T cell, phagocyte and complement systems are all normal
36
what are some different forms on severe combined immunodeficiency?
defects in Ag receptor gene rearrangements (RAG recombinases) defects in TCR signalling defects in cytokine R on the surface of T cells (IL2) defects in thymic development deficiencies in MHC expression (def in TAP)
37
hyper IgM syndrome?
defects in T cell dependant B cell activation via CD40 and CD40L = no cytokines released to undergo class switching
38
deficiencies in what aspects of complement leave ind susceptible to neisseria?
``` MAC deficiency (C5-9) C3 deficiency alternative pathway deficiency (C1-C4) ```
39
defects in phagocyte cell number and function
defects in phagocyte production (no polymorphonuclear development) defect in phagocyte adhesion - inability to leave blood and migrate though the tissues - leukocyte adhesion deficienes defects in phagocyte killing - mutations that affect generation in ROS involved in killing = no killing = wall off organism = chronic granulomatous disease defects in phagocyte activation = mutations in TLR
40
10 warning signs of PID?
4+ new ear infections within 1 year 2+ serious sinus infections within 1 year 2+ months on AB with little effect 2+ pneumonias within 1 year failure of infant to grow / gain weight recurrent deep skin or organ abcesses persists thrush in mouth or recurrent fungal infections of skin need for IV AB to clear infection 2+ deep seated infections including septicaemia family hx of PID
41
tx options for PID?
isolation - inactivated vaccine Ab prophylaxis replacement therapy (IVIG)
42
what are some things that secondary immune deficiencies are associated with?
``` malnutrition excess exercise CKD drugs infections zinc/vit defs stress old age ```
43
some features of immunosenescence
relative decrease in circulating CD4, relative increase in circulating CD8 T cell function in vitro and DTH decreases older ind have high serum Ab titre levels of IgA
44
what are some components affect in the immune system in EC bacteria?
phagocytes AB complement
45
A child presents with recurrent abscesses from Staphyloccocus aureus abscess. Which of the following is the most likely primary immune deficiency?
chronic granulomatous infection (neutrophil/ phagocyte defect)
46
A disease causing recurrent pyogenic infections is caused by dysfunction of
Phagocytes are defective in chronic granulomatous disease. Myeloperoxidase may be deficient but the vast majority of patients with myeloperoxidase deficiency do not experience disease
47
Its absence in normal newborns leads the increased risk of infection with gram negative enteric organism
IgM is too large to cross the placenta and protects against these organisms
48
Its absence is one of the defects found in autosomally inherited Severe Combined Immune Deficiency
ADA (adenosine deaminase) deficiency causes severe dysfunction of B, T and NK cells. Unlike the most common defect in SCID, which is X-linked, ADA deficiency is autosomal
49
which gender are PIDS more common?
boys
50
llergic urticaria is best described as being a manifestation of:
IgE mediated disorder
51
The tuberculin test is a delayed-type hypersensitivity reaction involving Th1 cells. What is the product injected subcutaneously to elicit this response?
small amounts of peptides and carbohydrates derived from M. tuberculosis
52
what defect is associated with chronic granulomatous disease?
Neutrophils and macrophages require the enzyme NADPH oxidase to produce reactive oxygen species, for respiratory burst (ie. to destroy bacteria after phagocytosis). Defects in subunits of NADPH oxidase can cause CGD.
53
effects of malnutrition?
The deficiency of nutrients has effects on: • Low availability of complement components + impaired phagocyte function • Decrease function of B cells + macrophages • Protein malnutrition → atrophy of primary lymphoid organs and immune cells
54
who is at high risk for CVD?
``` diabetes and >60 y/o diabetes with microglobulineamia CKD previous dx of familial hypercholesteremia SBP >180, DBP >110 serum cholesterol >7.5 ABTSI >74 ```
55
HTN preventative intervention?
measure BP on 2 different occsaions offer lifestyle modifications medications - BP 140/90 is those with CVD and 130/80 for those with diabetes
56
who is clinically determined high risk for HTN?
``` diabetes and age >60 diabetes with microalbumineria moderate/ severe CKD previous dx of FH SBP>180; DBP>110 serum cholesterol >7.5 ABTSI >74 ```
57
who is at high risk for lipids/ cholesterol and need lipid lowering mechanisms?
coronary heart disease and peripheral vascular disease = symptomatic DM Fx of CHD - systematic before age of 55 in 2 relative or before the age of 45 in 1 relative
58
when would you tx any level of hyperlipademia?
indigenous >60 microalbuminuria
59
tests to detect diabetes?
fasting blood glucose test oral glucose tolerance test AUSRISK

Year 3 Sem 1 (12 decks)

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